[Prescription of non-steroidal anti-inflammatories and gastric protectors in emergency service]

[Prescribing non-steroidal antiinflammatory drugs and gastrointestinal protection in primary care]

OBJECTIVE

To assess whether prescribing non-steroidal anti-inflammatory drugs (NSAIDs) is adequate for gastrointestinal protection associated with NSAID use.

DESIGN

Cross-sectional descriptive study.

SETTING

Primary Care Centre in La Mina, Barcelona, Spain.

PARTICIPANTS

A random sample of 500 patients, stratified by doctor was selected from a total of 4504 patients with an NSAID prescription.

MAIN MEASUREMENTS

The dependent variables were the adequacy of NSAID prescription and gastrointestinal protection. The independent variables were: age, sex, concomitant treatments, type and number of NSAIDs. The variables were collected from the clinical history.

RESULTS

The 476 patients included with an NSAID prescription had a mean age of 47.9 (18.1) years, and 63.4% were women. The NSAIDs most prescribed were, ibuprofen (60.3%), diclofenac (23.1%), and naproxen (4.0%). The most common reason for prescribing the NSAID was locomotor system pathology; 45.4%. The prescription was adequate in 44.7% (95% CI, 40.2-49.3), and inadequate in 23.5% (95% CI, 19.8-27.6). It was inadequate in 49.5% of patients over 65 years, while in under 65 year-olds 16.5% were inadequate. Gastrointestinal protection was inadequate in 28.2% (95% CI, 22.7-35.7); 12.8% excessive and 16% insufficient. In the multivariate analysis, the inadequacy probability of NSAIDs is 5.45 times greater in patients of 65 or more years than in younger patients.

CONCLUSIONS

NSAID prescribing and gastrointestinal protection can be considered to be inadequate in 25% of patients. Advanced age is a major risk factor in inadequate prescribing.

Estudio de prescripción-indicación de inhibidores de la bomba de protones

OBJECTIVES

To evaluate the adaptation of Proton Pump Inhibitors (PPI) prescriptions to the indications in the literature. To determine which doctors, patients and prescriptions characteristics are related to a correct prescription and to measure their relative importance.

MATERIAL AND METHODS

Cross-sectional observational study of prescription indication in an Urban Primary Care Center. Simple Random Sampling was used from primary care center patients PPIs prescriptions between July and December of 2003. Non-electronic prescriptions (OMI-AP program) were excluded from the sample. 412 PPI prescriptions were necessary as sample size to obtain a 95% confidence with a 4.7% precision and a 50% expected proportion. Simple random sampling techniques were used.

RESULTS

Prescription was correct under adequacy criteria in 36.4% of the cases. The effect of the "hiatal hernia" and "user activity status" variables showed the major impact on results with an OR: 0.361 and 1.672 respectively. NSAID treated patients PPIs prescriptions matched adequacy criteria in 79.5% of the cases. "Prescription source" and "User activity status" variables gave the highest impact with an OR: 2.5 and 4.52, respectively.

CONCLUSIONS

The high percentage of non-adequate prescriptions together with the differences found between primary and specialized levels of attention, could suggest lack of knowledge of PPIs prophylactic indications and lack of coordination between different levels of attention that could be solved by creating common performing protocols.